Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
College of Nursing-PMHNP, Walden University
NRNP-6635-15-Psychpathology Diagnoses Reasoning
Subjective:
CC (chief complaint): Issue with alcohol abuse and
HPI: P.A is a 48 years old female who is currently teaching at highschool. She was asked to talk to the school EAP councelor due to several complain from the parents and student about her coming to school drunk and sleeping in class while she asked the student to copy note from board and read from their textbook while she sleeps in class. According to the school, she have been late to school 22 days so far this calender years. During the interview, she admitted that she had a lot of alcohol during the history department party last night and she passed out in couch, which she lead to her coming to school late the following morning. She also admits that she have passed out in other occasions. She mentioned that she drinks to release stress from students. She stated that drinking alcohol does not affect her relationships both her ex and current boyfriend, but admits that her drinking has gotten higher than it was.
Past Psychiatric History:
• General Statement: Patient was asked to talk to the school EAP counselor due to her drinking problems and how it affects to students to avoid her getting fired. She admits drinking a lot every night. She was sounding irritated and stressed out throughout the interview, but later calmed down.
• Caregivers (if applicable): None
• Hospitalizations: N/A
• Medication trials: None
• Psychotherapy or Previous Psychiatric Diagnosis: N/A
Substance Current Use and History: Drinks a lot of alcohol every night,
Family Psychiatric/Substance Use History: Her father was an alcoholic, until he finally get help with the help of her mother’s support and AA meetings.
Psychosocial History: She was an only child, raised by parents in San Francisco, CA. She has a has PhD in biology and master’s degree in high school education (8–12). She is currently in a relationship.
Medical History: N/A
• Current Medications: None
• Allergies: N/A
• Reproductive Hx: N/A
ROS:
• GENERAL: . She reports no weight gain, or weight loss.
• PSYCHIATRIC: Reports alcohol use
• Objective:
Physical exam: She refused lab, and vitals
General: Patient is alert and oriented X4. She dressed appropriate, and well grommed.
HEENT: Normocephalic, Right and left PERRL, no hearing problem noted.
Respiratory: Chest wall was symmetrical when breathing. No SOB noted
Skin: Skin intact, no rashes noted
Psychiatric: Irritated and aggravation during interview.
Diagnostic results: N/A
Assessment:
Mental Status Examination: For the purposes of your courses, this section must be presented in paragraph form and not use of a checklist! This section you will describe the patient’s appearance, attitude, behavior, mood and affect, speech, thought processes, thought content, perceptions (hallucinations, pseudohallucinations, illusions, etc.)., cognition, insight, judgment, and SI/HI. See an example below. You will modify to include the specifics for your patient on the above elements—
He is an 8-year-old African American male who looks his stated age. He is cooperative with examiner. He is neatly groomed and clean, dressed appropriately. There is no evidence of any abnormal motor activity. His speech is clear, coherent, normal in volume and tone. His thought process is goal directed and logical. There is no evidence of looseness of association or flight of ideas. His mood is euthymic, and his affect appropriate to his mood. He was smiling at times in an appropriate manner. He denies any auditory or visual hallucinations. There is no evidence of any delusional thinking. He denies any current suicidal or homicidal ideation. Cognitively, he is alert and oriented. His recent and remote memory is intact. His concentration is good. His insight is good.
Differential Diagnoses: What were your differential diagnoses? Provide a minimum of three possible diagnoses with supporting evidence, listed in order from highest priority to lowest priority. Compare the DSM-5 diagnostic criteria for each differential diagnosis and explain what DSM-5 criteria rules out the differential diagnosis to find an accurate diagnosis
Reflections: What would you do differently with this client if you could conduct the session over? Also include in your reflection a discussion related to legal/ethical considerations (demonstrate critical thinking beyond confidentiality and consent for treatment!), health promotion and disease prevention taking into consideration patient factors (such as age, ethnic group, etc.), PMH, and other risk factors (e.g., socioeconomic, cultural background, etc.).
Legal and ethical issues.
References
Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-114-2.
Week 8: Assessing and Diagnosing Patients With Substance-Related and Addictive Disorders
College of Nursing-PMHNP, Walden University
NRNP-6635-15-Psychpathology Diagnoses Reasoning
Subjective:
CC (chief complaint): Issue with alcohol abuse and
HPI: P.A is a 48 years old female who is currently teaching at high school. She was asked to talk to the school EAP counselor due to several complaints from the parents and students about her coming to school drunk and sleeping in class she asked the student to copy notes from the board and read from their textbook while she sleeps in class. According to the school, she has been late to school 22 days so far this calendar year. During the interview, she admitted that she had a lot of alcohol during the history department party last night and she passed out on the couch, which lead to her coming to school late the following morning. She also admits that she has passed out on other occasions. She mentioned that she drinks to release stress from students. She stated that drinking alcohol does not affect her relationships with both her ex and current boyfriend, but admits that her drinking has gotten higher than it was.
Past Psychiatric History:
- General Statement: The patient was asked to talk to the school EAP counselor due to her drinking problems and how it affects to students to avoid her getting fired. She admits to drinking a lot every night. She was sounding irritated and stressed out throughout the interview, but later calmed down.
- Caregivers (if applicable): None
- Hospitalizations: N/A
- Medication trials: None
- Psychotherapy or Previous Psychiatric Diagnosis: N/A
Substance Current Use and History: Drinks a lot of alcohol every night,
Family Psychiatric/Substance Use History: Her father was an alcoholic until he finally get help with the help of her mother’s support and AA meetings.
Psychosocial History: She was an only child, raised by parents in San Francisco, CA. She has a PhD in biology and a master’s degree in high school education (8–12). She is currently in a relationship.
Medical History: N/A
- Current Medications: None
- Allergies: N/A
- Reproductive Hx: N/A
ROS:
- GENERAL: . She reports no weight gain, or weight loss.
- PSYCHIATRIC: Reports alcohol use
- Objective:
Physical exam: She refused lab, and vitals
General: The patient is alert and oriented X4. She dressed appropriate and well groomed.
HEENT: Normocephalic, Right and left PERRL, no hearing problem noted.
Respiratory: Chest wall was symmetrical when breathing. No SOB noted
Skin: Skin intact, no rashes noted
Psychiatric: Irritated and aggravation during the interview.
Diagnostic results: N/A
Assessment:
Mental Status Examination:
The 48-year-old female patient appears her age. She is well dressed for the occasion. During the interview, she answers the questions as required and is equally cooperative. However, she is irritated and aggravated. She makes different faces whenever asked questions directly related to her alcoholic behavior. She varies her tone severally especially when she is irritated. She also seems moody during the interview session. She has no signs of hallucinations or suicidal ideation. She has a good concentration and memory span as she can recollect some work experiences that have significantly stressed her in the past. She is alert and oriented.
Differential Diagnoses:
Based on the patient’s history, the differential diagnosis is alcohol use disorder, major depression and bipolar disorder.
Alcohol Use Disorder
Alcohol use disorder is the primary diagnosis for this patient based on her history. The DSM-5 criteria define alcohol use disorder as a maladaptive pattern of substance abuse that causes distress or impairment. The condition is manifested by 2 or more of the following signs; must occur for 12 months, alcohol should be taken in huge amounts and for a period longer than was intended. Besides environmental factors, peer interactions, and existing personality disorders, alcohol use disorder is also linked to genetic factors. The patient’s father was an alcoholic (Nehring & Freeman, 2021). The patient has a history of coming to school drunk and delegating work, has been drinking more than before, and during last night’s party, she drank too much and ended up passing out on the couch resulting in her coming to school late.
Major Depressive Disorder
The second differential diagnosis is a major depressive disorder. Major depressive disorder refers to a psychiatric condition that according to the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) is characterized by the presence of a depressed mood, low energy levels, loss of interest in pleasurable activities, poor concentration, poor sleeping patterns and poor feeding habits for 2 weeks (American Psychiatric Association, 2013). The patient seems depressed and is unhappy with her workstation and the things she has to put up with in order to pay her bills. She regularly complains about how unsupportive her workplace is of teachers which have made her no longer enjoy teaching as a career. She also confides to the counselor that she drinks to enable her to cope with the entitled and spoilt rich students.
Bipolar Disorder
Bipolar disorder is the third differential diagnosis. Bipolar disorder is a mental health condition whose signs ad symptoms include mood changes, depression episodes, and manic episodes affecting the patients’ well-being and their quality of life. People that are diagnosed with the condition usually experience difficulties in work, relationships, and social interactions. Based on the patient’s history of alcohol use and dependency and clinical manifestation, she could be having bipolar due to her depressive episodes. Vieta et al. (2018) claim that substance use disorders that can be predicted by an extended time of alcohol experimentation and a family history of substance use are risk factors for the development of the bipolar disorder.
Reflections:
If I were to have another session with this patient is to create a safe environment for her to be open considering that she feels that the teachers in the institution have no support and backbone. I would educate the client about the impact of excessive alcohol use such as the development of diseases like liver cirrhosis or worst still she could be retrenched from her position resulting in financial instability and more stress.
Legal and ethical issues.
Some of the ethical considerations that the case study presents concern the issue of the relationship between the client and the counselor. Since they are colleagues, the client is likely to withhold some information or better still take the session casually hindering her from benefiting.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
Nehring, S. M., & Freeman, A. M. (2021). Alcohol Use Disorder. StatPearls [Internet].
Symptom Media. (Producer). (2018). Training title 114-2 [Video]. https://video-alexanderstreetcom.ezp.waldenulibrary.org/watch/training-title-114-2.
Vieta, E., Salagre, E., Grande, I., Carvalho, A. F., Fernandes, B. S., Berk, M., … & Suppes, T. (2018). Early intervention in bipolar disorder. American Journal of Psychiatry, 175(5), 411-426.